Endoscopy is a minimally invasive surgical procedure which utilizes imaging apparatus for the purpose of providing a view of an interior portion of the body, without requiring that a large surgical opening be made in the patient to gain access to the surgical site. An endoscope is one type of such imaging apparatus which is placed in the body at the location at which it is necessary to perform a surgical procedure. Along with the endoscope, other types of surgical tools or instruments may be placed in the body at the surgical site so as to carry out a particular procedure. Examples of such instruments are cutting instruments, such as shaver-type devices which mechanically cut bone and hard tissue, or radio-frequency (RF) probes which are used to remove tissue via ablation or to coagulate tissue to minimize bleeding at the surgical site, to name only a few. In an endoscopic procedure, the surgeon views the surgical site through the endoscope in order to manipulate the other surgical instrument or instruments so as to perform the desired surgical procedure.
The development of endoscopes and their companion surgical instruments has made it possible to perform minimally invasive surgery that requires only small openings to be made in the patient, which openings are called portals. One advantage of performing endoscopic surgery is the reduction of the number of incisions made in the patient and/or the reduction of incision size, which reduces healing time after surgery. Still another advantage of endoscopic surgery is that it exposes less of the interior tissue of the patient's body to the open environment. This minimal opening of the patient's body lessens the extent to which the internal tissue and organs are open to infection.
In traditional endoscopic surgery, the endoscope and the surgical instrument are introduced to the surgical site through separate small portals, and once inside the patient, the instrument and endoscope must be correctly spatially oriented relative to one another through triangulation. Specifically, the surgeon must place the working end, typically the distal end, of the surgical instrument within the field of view of the endoscope so that the surgical instrument can be correctly manipulated, and must continually maintain this correct spatial relationship between the endoscope and the instrument throughout the surgical procedure. Since the surgical instrument and endoscope are inserted into the patient at varying angles and from separate locations, maintaining the correct spatial relationship between the two devices can be taxing on the surgeon. Further, during multiple-portal endoscopic surgery, surgical instruments, such as the blade of a surgical shaver or an RF probe, may collide with the endoscope optics, which can damage the endoscope and/or potentially cause a delay in surgery. Additionally, it can be difficult for surgeons to maintain the proper location of the endoscope within the surgical site during surgery.
While endoscopic surgery has been very successful in carrying out various surgical procedures, the medical field continually strives to lessen trauma caused to the patient during an endoscopic surgical procedure, and the number of portals created in the patient has been reduced from three portals to two portals by expanding the functionality of the endoscope itself and of other surgical instruments. Further, the present trend in endoscopic procedures is to perform all necessary surgical functions through a single portal. One of the challenges presented by single-port surgical procedures is preventing stretching and/or tearing of the incision defining the single portal as the surgical instruments are manipulated and levered relative to the patient while same extend into the patient through the portal.
In view of the above, one object of the present invention is to require the formation of only a small, single incision in the patient during endoscopic surgery by maintaining the various surgical instruments and the endoscope in the correct spatial orientation relative to one another to effectively prevent undesirable deviation of these tools during surgery, and to maintain the endoscope at the proper depth within the surgical site. A further object is to allow ready positioning of the surgical instrument relative to the endoscope so that the surgical instrument is inserted into the patient directly into the field of view of the endoscope.
In this regard, the present invention includes an access and positioning arrangement which is intended for placement or positioning adjacent or in some situations atop the skin of the patient where the incision or portal is located and through which portal the surgical site is accessed. The arrangement according to the invention thus acts an exterior access point to the surgical site which effectively defines multiple pathways leading thereto through a single incision defined within the patient. The arrangement includes a hub having a housing defining therein a pair of channels which are sidewardly-spaced from one another within an interior of the housing and which communicate with the surgical site via the portal defined in the patient. Respective surgical instruments or tools are inserted into the respective channels for extension into the surgical site through the portal, which channels serve to maintain the instruments in a predefined and fixedly-spaced relation with one another.
The arrangement in some embodiments additionally includes a clamping or locking arrangement which cooperates with at least one of the channels defined in the housing so as to non-movably fix the surgical instrument located within the channel relative to the housing and/or at the proper location within and relative to the surgical site. According to a preferred usage of the arrangement, one of the surgical instruments is an endoscope assembly including an elongated shaft which is inserted in the aforementioned channel or scope channel, and when located at the proper depth or location relative to the housing and/or surgical site, the clamping arrangement is engaged so as to fix the endoscope assembly at the selected position. A further surgical instrument, such as a shaver, burr or drill, for example, is inserted into the opposite or working channel defined in the housing and can be utilized to manipulate tissue at the surgical site. In this regard, the working or distal end of the shaver or other instrument must be placed and maintained within the field of view of the endoscope so that the surgeon can correctly manipulate the instrument and carry out the surgical procedure. In this regard, one embodiment of the invention incorporates an elongate channel member which is cantilevered from the housing in a position so as to communicate with, and form an extension of, the working channel through which the shaver or other tissue-manipulating instrument extends. The length of the channel member as well as the orientation of same relative to the scope channel defined in the housing is such that the tissue-manipulating instrument can be readily placed and maintained in the field of view of the endoscope during the surgical procedure.
The arrangement according to one embodiment of the invention incorporates a sealing arrangement so as to prevent undesirable fluid leakage from the surgical site and also to help maintain in-joint pressure when the arrangement is utilized in arthroscopic surgery, for example. In a further embodiment, the seal arrangement and channel member are dispensed with which provides more flexibility in positioning the surgical instrument by allowing the surgeon to achieve a greater angle of deviation between the surgical instrument and the endoscope.
As an alternative to a clamping or locking arrangement which is actively engaged or disengaged by the user, the surgical instrument can be fixed in a desired position relative to the housing utilizing a friction-fit or interference-type arrangement. In this regard, at least one of the channels defined in the housing engages the surgical instrument inserted therein with a friction or interference-type fit such that the instrument can be maintained at the desired depth relative to the surgical site and/or relative to the housing simply by inserting the instrument into the channel until the desired depth is reached.
Certain terminology will be used in the following description for convenience in reference only, and will not be limiting. For example, the words “upwardly”, “downwardly”, “rightwardly” and “leftwardly” will refer to directions in the drawings to which reference is made. The words “inwardly” and “outwardly” will refer to directions toward and away from, respectively, the geometric center of the arrangement and designated parts thereof. The words “forwardly” and “distally” will refer to the direction toward the end of the arrangement which is closest to the patient, and the words “rearwardly” and “proximally” will refer to the direction toward the end of the arrangement which is furthest from the patient. Said terminology will include the words specifically mentioned, derivatives thereof, and words of similar import.